Question:
Teledentistry ?
Answer:
General dentists practicing in remote areas throughout Southern
California will soon be able to consult with dental specialists at the
UCLA School of Dentistry, thanks to an innovative new software developed
jointly with Houston-based PhysiTel Inc.
Called TeleDiagnosis™, the teledentistry software allows dentists to
automatically encrypt and e-mail patient information over the Internet.
The program acquires intraoral camera images, X-rays, voice mail,
onscreen notations and paper-based records, then digitizes and
compresses them into a single electronic patient chart. The information
travels in seconds over ordinary phone lines, enabling UCLA faculty to
review the patient's history, diagnose the problem and formulate a
treatment plan.
"Teledentistry is a whole new way of providing dental care," explained
Jeff Birnbach, PhysiTel's chief executive officer. "It eliminates
geographic boundaries and non-productive travel time. Now people living
in remote areas can benefit from the same high level of dental care as
patients in Los Angeles. UCLA specialists will provide timely
consultation services at an affordable price to patients who would
otherwise be beyond the UCLA practice's service area."
"This is designed for the general dentist in rural California who does a
fine job providing routine care, but possesses limited experience in
treating unusual oral disease," noted Dr. Glenn Clark, director of the
UCLA Oral Medicine and Orofacial Pain Faculty Group Dental Practice.
The UCLA practice specializes in diagnosing and treating chronic head
and neck pain, jaw joint disorders, salivary dysfunctions,
tooth-grindng, oral infections and oral tissue lesions, which affect an
estimated 15 percent of the population. "Practitioners now have the
advantage of consulting with UCLA faculty, whose clinical care and
expertise is shaped by the latest research findings in the field," added
Clark.
Other universities offer Web-based consultation services in medical
specialties, but UCLA is the first to venture into the mouth. "UCLA
will be the first dental school in the United States to launch a
teledentistry program of this type," Birnbach noted.
PhysiTel expects to put the finishing touches on TeleDiagnosis in
August. UCLA plans to distribute 10,000 complimentary copies of the
program to potential customers, who will be invited to try the service
on a free trial basis. UCLA will charge an hourly consultation fee
thereafter. The address on the World Wide Web will be
http://www.diagnosis.dent.ucla.edu.
To create TeleDiagnosis, PhysiTel built on the foundation of its
ChartMailer software and its soon to be released MediWorx program. These
products were developed from the results of clinical trials conducted at
medical centers throughout the US including Boston University, Duke
University and Johns Hopkins University. All three software programs can
be used on virtually any PC, laptop or notebook computer running Windows
95 or Windows NT. Users may also use the software from a computer
interfaced to a cellular phone modem to create a truly mobile healthcare
program.
This idea of sending patient information over the net (encryped or not) raises
my eyebrows. I'm wondering about how the privacy of the patient is managed.
Are the patients who are a part of Teledentistry's program aware that their
information is being emailed? What is a person told about why their
information is being encrypted... and does the patient know enough about what
that means to be able to say, "no thank you" if they prefer their information
not be sent out onto the net?
Will there be access to the people at UCLA who manage conditions called "TMD"
and also to those maxillofacial surgeons when there is a question of problems
secondary to TMJ surgery in the past... or perhaps the question of present
need?
I read the materials below concerning the UCLA services. Presently, there is a
thread in alt.support.jaw-disorders (What is a person to do?) from a person who
is considering the services of UCLA because her Kaiser doctors claim to know
nothing about "TMJ" care... Is Kaiser able to access these same people? Is
there some agreement between HMO's where jaw and jaw joint related pain and
dysfunction is not normally available onsite?
Sending encrypted patient information via the Internet is a more secure
form of information than FAX'ing a patient chart. When information is
FAX'd anyone walking by a FAX machine can view or intercept the
material. This can be an unauthorized nosey employee, or the wandering
eyes of a waiting patient while the receptionist is on the phone.
Using 128-bit DES encryption, only the intended receipient can decode
and view the electronic patient chart. 128-bit DES encryption has NEVER
BEEN BROKEN. Can we say no one has ever read a FAX intended for someone
else?
It's estimated that to decipher a single 128-bit DES encrypted image
would take several years. It's easier to break into a dentists office
and steal the patient charts from the file cabinet. The few messages
that have recently been broken were using 56-bit and 64-bit methods on
very short strings of basic text. One sentence at most. A 640x480x24 bit
image is orders of magnitude more complex that a single sentence.
As for your inquiry as to whether or not patients have an option of
having their providers use technology like this, one question comes to
mind. Do you ask your patients if you can use your photocopier in the
office? Or if you can put their information in your office computer?
Offices freely make copies of patient records when required and maintain
there records using the most advanced programs they can buy. Care
providers use the technology that's available to them. Those of us who
understand the technology see teledentistry as a continuation of the
evolution of information management.
When you examine the real features and functionality of the technology
and use protocol behind solutions like this teledentistry program,
encrypted email is the most secure and private form of communication
that can be deployed today. Even putting charts in an envelope and
mailing them has security risks. Programs like this will clearly
increase the level of care available to patients while at the same time
insuring patient privacy.
